| Objective: The aim of our study was to assess the value of high sensitive C-reaetive Protein (hsCRP) for the diagnosis of central nervous system(CNS) infection in children.Methods: 278 cases in the Paediatrics Department, the Second Hospital of Hebei Medical University from May, 2009 to Feb, 2010 were enrolled in our study. 74 cases of viral meningitis with other systems non-infected were seted as group1; 58 cases of viral meningitis with other systems infected were seted as group2; 70 cases of Hand, Foot and Mouth Disease with central nervous system infected were seted as group3; 36 cases of bacterial meningitis were seted as group4; 40 non-infected, epileptic cases were seted as control group. The examination of blood hsCRP concentration had been done by means of Immunofluorescence, blood routin test and cerebrospinal fluid (CSF) test had been done in the labroary of the hospital. Compared the concentrations of blood hsCRP among different groups and draw receiver operator characteristic curve (ROC curve). All statistical analyses were performed with spss 13.0.Results: 1. The blood hsCRP concentrations of the control group were all bellow 0.5mg/L.2. The blood levels of hsCRP in group1 were 0.56(1.8) mg/L. The hsCRP concentrations of 41(55.4%) cases were <0.5mg/L,33(44.6%)cases were≥0.5mg/L; 61(82.4%) cases were≤4 mg/L,13(17.6%) cases were >4 mg/L; 66(89.2%) cases were≤8 mg/L,8(10.8%) cases were >8 mg/L.3. The levels of blood hsCRP in group2 were 1.85(11.27) mg/L. The hsCRP concentrations of 22(37.9%) cases were <0.5 mg/L,36(62.1%) cases were≥0.5 mg/L; 35(60.3%) cases were≤4 mg/L,23(39.7%) cases were >4 mg/L; 42(72.4%) cases were≤8 mg/L,16(27.6%)cases were >8 mg/L. 4. The levels of blood hsCRP in group 3 were 1(3.56) mg/L. The hsCRP concentrations of 24(34.3%) cases were < 0.5 mg/L,46(65.7%) cases were≥0.5 mg/L; 53(75.7%) cases were≤4 mg/L,17(24.3%) cases were >4 mg/L; 57 (81.4%) cases were≤8 mg/L,13 (18.6%) cases were > 8 mg/L.5. The levels of blood hsCRP in group 4 were 23.7(81.1) mg/L. The hsCRP concentrations of 8 (22.2%) cases were≤8 mg/L,28 (77.8%) cases were > 8 mg/L;20(55.6%) cases were≤30 mg/L,16(44.4%) cases were >30 mg/L; 22 (61.1%) cases were≤50 mg/L,14 (38.9%) cases were > 50 mg/L.6. With the first group as the reference, draw the ROC curve of the levels of blood hsCRP in diagnosing bacterial meningitis. The best cutoff value was 5.15 mg/L,the sensitivity was 94.4%,the specificity was 83.8%,Youden index was 0.782,the area under the ROC curve was 0.949.When the cutoff value were 5.15 mg/L and 4 mg/L, the sensitivity and specificity were not significantly different (P>0.05), but significantly different with 8 mg/L (P<0.05).With the second group as the reference, draw the ROC curve of the levels of blood hsCRP in diagnosing bacterial meningitis. The best cutoff value was 6.35 mg/L,the sensitivity and specificity were 88.9% and 69%,Youden index was 0.579,the area under the ROC curve was 0.949.When the cutoff value were 6.35 mg/L and 10 mg/L, the sensitivity and specificity were not significantly different (P>0.05), but significantly different with 30mg/L (P<0.001)7. Compared the constituent ratios of blood hsCRP concentrations of group1, group2 and group3. There were significant differences between group1 and group3 when the hsCRP levels were <0.5 mg/L (P<0.05); When the hsCRP levels were <0.5 mg/L and >8 mg/L, the significant differences can be observed between group1and group2 (P<0.05) .When the hsCRP levels were 0.5-4 mg/L, the significant differences can be observed between group2 and group3 (P<0.05). 8. When the cutoff value was 10 mg/L, the constituent ratios of group1 and group4 were significantly different (P<0.05), When the hsCRP levels were<8 mg/L and >30 mg/L ,they were also significantly different (P<0.05)between group2 and group4.9. The hsCRP concentrations of group1 had negative relationship with the percentages of blood lymphocytes (rs=-0.412, P<0.01).(the age of patients was above 4)10. The hsCRP concentrations of group4 had positive relationship with the number of cerebrospinal fluid (CSF) white blood cell (rs=0.621,P <0.01).11. The significant difference of hsCRP concentrations was observed in group4 between pretreatment (23.7(81.1) mg/L) and aftertreatment (2(15) mg/L) (P<0.05).Conclusions: 1. The detection of blood hsCRP adds a valuable adjunct in the rapid diagnosis of CNS infection.2. Test the concentration of blood hsCRP dynamicly could observate the efficacy and development of illness.3. In this test, the best cutoff value of blood hsCRP concentration was 5.15 mg/L between viral meningitis with other systems non-infected cases and bacterial meningitis cases, the value was 6.35 mg/L between viral meningitis and with other systems infected cases and bacterial meningitis cases.4. The blood hsCRP concentrations in Hand, Foot and Mouth Disease with central nervous system infected cases were higher than viral meningitis with other systems non-infected cases and viral meningitis,but can not assess the condition.
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